Unit 8 -- The Complicated Nature of Grief in Families

Grief in a Family Context --HPER F460/F560

Goals for this Unit

Grief within families is a complicated business. In this unit, we will
address some of the ways in which this occurs by exploring what we have
come to know as "complicated grief" and by looking at ways in
which the process of grief within the family can become complicated.

Preliminaries

This unit will be different from earlier ones, and will serve as a transitional
unit. In it, we will draw on information from earlier units for characteristics
of bereaved individuals and families that may lead to complicated grief.
This will act as a bridge to Units 9 through 12, which will explore characteristics
of the loss situation that have a greater likelihood of complicating grief. Remember to post questions, observations, and insights on the readings in the e-anthology and for the "lecture" provided by Dr. Gilbert on Oncourse.

Another way in which this unit will be different is that questions
will be embedded throughout the unit rather than being saved for the end. They will be in red and in a different font to make it easier for
us to locate them. For these questions, read at least two interviews by
your fellow class mates (in the Folder dedicated to interviews) or go to the archived
cross-cultural interviews and incorporate them in your discussion. Also,
unlike the units you have already done, you are required to answer ALL of the
questions.

As you read through this unit, we want you to view grief as complicated
in two different ways: first, within the context of individual family members,
that is, as the atypical grief of individual family members; second, within
the context of the family as an environment that can be a potentially complicating
factor for the grief of family members. Before reading the rest of this
unit, think about how you view complicated grief within the family.

This unit will seem unusually short when you first see it. This is
intentional. You're being asked to return to earlier units, to look
at the information in them through a new "lens," that of complicated
grief. Throughout this unit, you'll be drawing on your readings,
material from previous units, and on your analytical skills, to look at
ways in which grief may and may not be complicated within families.

Readings

Anthology

(Re-read) Gilbert, K. R. 'We've had the same loss, why don't we have the same grief?' Loss and differential grief in families.

Web Resources

"Lecture"

You'll remember that, in Unit 1, you were asked to define what you
saw as unhealthy grief. In many cases, you described complicated
grief. You may find, by now, that your view has changed or expanded.

Question 1: I'd like you to go back
to your definition of unhealthy grief and see what your thoughts are now.
Have they changed? Do you think that complicated grief, the topic
of this unit, is necessarily unhealthy? What are the implications for your view as an "outsider" reading the two interviews you read? Tell us why you feel
this way.

As you read in Rando's article, a great deal of controversy exists over
the definition of what we are calling "complicated grieving."
It also has been called many other name, including abnormal, atypical,
unresolved, dysfunctional, unhealthy, and, most commonly, pathological
grief. We have had tremendous difficulty in operationalizing this form
of grief (that is, we have had problems in setting a clear, measurable
set of criteria for defining "complicated grief"). As we
saw in the first unit, grief is defined in a wide
variety of ways. Given that uncomplicated grief does not have a single
definition, it should not be surprising that complicated grief does not
have a single definition. We did, I want to point out, discuss the
four forms of complicated grief, as seen by Worden, in that unit.
I encourage you to visit that unit and look at the section covering grief as an illness

Family forms and ongoing family processes influence the grief response
of individual family members (Unit 2),
as do relationships, both with others and the ongoing, but altered, relationship
with the deceased (Unit 6). The relationship
with the deceased at the time of death is an important factor. Interestingly,
it is not necessarily the death of someone with whom we have a close and
warm relationship that leads to complicated grief. It may, in fact,
be the death of someone with whom we have a conflictual relationship, especially
if we feel that relationship should have been warm and close, that is more
likely to lead to complicated grief.

Other factors that add complexity to the picture are age and development,
which we discussed in the units on early and later development, gender, and
culture. Each of these can contribute
to a situation in which someone's grief is viewed by others as unhealthy,
pathological, or disabling, yet can also be seen as appropriate by another.

Worden (1991, pp. 75-77) proposed a list of indicators of unresolved grief
that he put forward as diagnostic criteria to be used by clinicians.
The indicators include:

The person cannot speak of the deceased without experiencing intense
and fresh grief.

Some relatively minor event triggers an intense grief reaction.

Themes of loss come up in conversation.

The person who has sustained the loss is unwilling to move material
possessions belonging to the deceased.

The person who has sustained the loss develops the symptoms like those
the deceased experienced before death.

Those who make radical changes in their lifestyle following a death
or who exclude from their life friends, family members, and/or activities
associated with the deceased.

A person who has had a long history of subclinical depression, often
earmarked by persistent guilt and lowered self-esteem. The opposite
(a false euphoria after a death) may also indicate that grief is complicated.

The person has a compulsion to imitate the dead person, particularly
if he or she had no conscious desire nor competence for the same behavior.

Self-destructive impulses may be stimulated by unresolved grief.

Unaccountable sadness occurring at a certain time each year can be
a clue to unresolved grief.

A phobia about illness or death is often related to the specific illness
that led to or caused the death.

The circumstances around the death can contribute to complicated grief
(We will, by the way, be going into this in much greater detail in Units
10 through 13).

In the article by Rando, you read about another way to thinking about complicated
grief (please note that Rando speaks of complicated mourning--this is not
the way we use the term in this class--in clinical psychology and psychiatry,
mourning and grief often are used interchangeably). In this, grief is complicated if, after accounting for the
timeframe, there is compromise, distortion, or failure of one or more of
the six "R" processes of grief:

Recognize the loss

React to the separation

Recollect and reexperience the deceased and the relationship

Relinquish the old attachment to the deceased and the old assumptive
world

Readjust to move adaptively into the new world without forgetting the
old

Reinvest

Question 2: Look at these factors and think
of them in the context of age, development, gender and culture. How
do you see each of these factors potentially leading to a complicated grief
reaction?

In looking at the family as an environment of grief, it was suggested that families can contribute to the complicating of the grief process of family members, which is addressed in the Gilbert article you were assigned to re-read. In previous semesters, during this unit, we also discussed how families can act as a buffer, reducing
the complications of grief (which we also alluded to in Unit
6.) Cendra suggested elements of the circumplex model (Olson,
1995) as useful for understanding family process and grief.

The Circumplex Model is comprised of two dimensions, Cohesion and Adaptability.
The cohesion dimension ranges from low, Disengaged, through Separated and Connected, to
high, Enmeshed. Adaptability ranges from low, Rigid, through Structured and Flexible, to
high, Chaotic. If you picture a 4 X 4 table that results in 16 cells, you have a sense of what the circumplex model looks like. A very rough picture of this is presented below (incidentally, if you're using a text only browser, let me know. I'll fax a copy of this image to you):

Each of the 16 cell in the table represents one family type. For example, if a family was high in adaptability and low in cohesion, that
family would be classified as chaotically disengaged.

According to Olson, these dimensions are curvilinear, that is, the four
central categories of the table are considered balanced families, and are
seen as the most functional. These are flexible-separated, flexible-connected,
structured-separated, and strucured-connected. Mid-range families
are extreme on one dimension, yet are balanced on the other dimension,
and there are eight cells in this category. Families at the extremes
of both dimensions are considered the least functional.

Families are in an ongoing struggle to maintain a balance between the
extremes of cohesion and adaptability, between connectedness and separateness
and between organization and disorder. Olson suggests that balanced
families have more balanced communication skills.

Cendra also suggested that we look at such classification systems and
look at them in terms of functional and dysfunctional family activity.
She defined these in the following ways:

Functional means the family members share common goals and beliefs
and that their interactions are generally productive and in accord with
these goals and beliefs.

Dysfunctional means that the family members may not share common
goals or beliefs and that their interactions are generally nonproductive and directed toward different and potentially often conflicting goals and beliefs. This can lead to conflict and disaffection among family members.

Question 3: With this model in mind, consider
how it might be used to understand and explain the potential for complicated
grief within families. How might family form affect the grief of its family members? Do you agree that families classified as balanced are the most function, especially at the time of a loss? How might the ethnicity of a family
complicate the classification of a family? Could there be, for example,
families that might be extreme by the standards of this model but would
be functional in the context of their culture? Going back to our discussion of
"no family can think, feel, grieve," can a family be defined as
functional or dysfunction? Can a family be functional for one member's grief
and not for another?

Finally, the article you re-read on differential grieving proposed that
families can contribute to more complicated grief. We discussed this
earlier in the semester and you're asked to re-visit this question:

Question 4: We have had the proposition put before us that families cause grief to be complicated. You might argue the opposite. Could both positions be true, simultaneously? Are these necessarily oppositional--that they can only cause grief to be complicated or only facilitate uncomplicated grief?

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